State Not Making the Grade on the Healthy Families Transition

Sacramento, CA – Today, children’s health advocates gave the State of California a C-minus on the transition of 875,000 children from the Healthy Families Program to Medi-Cal. The advocates noted that while the state is doing fine in some aspects of the transition, the state’s inadequate planning and monitoring processes raiseconcernsthat it may be ill-prepared to prevent children from falling through the cracksas they move to Medi-Cal in the more complicated phases later this year. Although, as expected, children in the first transition phase did not lose coverage, the state simply fell short of what the Legislature required and what the state negotiated with the federal government.

Report Card on the Healthy Families Transition to Medi-Cal

Phase 1A

Future phases

Maintaining access to coverage

A

Ensuring continuity of care

C+

Tracking children’s outcomes

D

Quality of first monthly monitoring report

D

Communication with families

B+

Provider engagement

D

Network adequacy assessment

D+

Stakeholder engagement

A-

Coordination with other agencies (i.e. MRMIB)

D

Compliance with federal requirements

C-

Compliance with state statute

D

Criteria for determining success

F

Overall

C-

The California Department of Health Care Services issued the first required monthly report to the Legislature on February 15, highlighting that there have been no identified widespread problems with children losing coverage due to the transition. However, children’s health advocates issued their own report card, pointing to several inadequacies in the state’s report and transition progress.

“While we are pleased that the children that havemoved so far have maintained access to health coverage, the state is grading itself on a curve when they assert the transition is going smoothly. The state’s report fails to provide critical information and context that would more accurately reflect the dangers children face in this transition,” said Ted Lempert, President of Children Now. “The state should learn lessons from the roll-out of the first phase and put in place a robust monitoring system to identify problems that arise before moving forward with future transition phases.”

The state began moving children from Healthy Families to Medi-Cal on January 1, 2013, starting with almost 200,000 children who were in health plans that stated they were ready to transition children without jeopardizing their health. Major disruptions in coverage or care were not anticipated in the first phase. In the coming months, more than 650,000 additional children will be moved in phases, including children in counties where there are a severely limited number of doctors and dentists.

“The real test of the transition will be what happens in the later phases when manychildren will need to change health plans or doctors, and couldface significant challenges getting care when they need it,” said Jamila Edwards, Northern California Director of Children’s Defense Fund-California. “We also know that problems may arise once families start trying to make appointments to see a doctor, dentist or mental health provider. And because the monitoring of this process is sorely lacking, we may never know if these children are able to get an appointment.”

The state’s report lacked meaningful information on outcomes for children who have faced disruptions due to the transition and there is no information about whether the 1,847 children who were unable to keep their Healthy Families doctor were connected with a new doctor in a timely fashion, able to obtain care quickly, and achieve or maintain good health. In addition, a preliminary survey indicated that pediatricians were concerned about the impact the transition might have on children and many pediatricians felt uninformed about the transition.

The Assembly Health Committee and the Assembly Budget Subcommittee on Health and Human Services will hold a joint hearing to review the transition progress on Thursday, February 28, 2013 upon adjournment of floor session (approximately 10:00am) in the State Capitol Room 4202. In advance of the hearing, more than 850 California parents, grandparents and caregivers joined MomsRising in urging California legislators to carefully monitor the transfer of children from the Healthy Families Program to Medi-Cal.The state needs federal approval before they can move forward with the next transition phase, which is scheduled to happen this Friday, March 1st.

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The 100% Campaign, a collaborative effort of The Children’s Partnership, Children Now andChildren's Defense Fund-California was created in 1998 to ensure that all of California’s children obtain the health insurance they need to grow up strong and healthy. www.100percentcampaign.org

The Children's Partnership (TCP) is a national, nonprofit child advocacy organization working to ensure that all children - especially those at risk of being left behind - have the resources and the opportunities they need to grow up healthy and to lead productive lives. TCP focuses particular attention on securing health coverage for uninsured children and ensuring that the opportunities of digital technology benefit all children and families.

Children Now is a nonpartisan research and advocacy organization working to raise children's well-being to the top of the state and national policy agenda. Children Now focuses on ensuring quality health care, a solid education and a positive media environment for all children.

Children's Defense Fund-California is the California office of the Children's Defense Fund, a non-profit child advocacy organization that has worked relentlessly for 35 years to ensure a level playing field for all children. The Children’s Defense Fund champions policies and programs that lift children out of poverty, protect them from abuse and neglect, and ensure their access to health care, a quality education, and a moral and spiritual foundation.

PICO Californiais the largest grassroots congregation-based community organizing network in California. Nineteen local California PICO federations organize in 73 cities and 35 school districts, reaching from Placer to San Diego County. Together, PICO federations represent 450,000 families of diverse economic, racial, ethnic, and religious backgrounds across the state. PICO California is part of the PICO National Network, which includes organizations in 16 states. www.picocalifornia.org

United Ways of California (UWCA) is the state association for California’s local United Ways. UWCA works to improve the health, education and financial stability for low-income children and families by enhancing and coordinating the advocacy and community impact work of California’s United Ways. UWCA is a strong advocate of expanding health coverage to all California children and their families. United Ways work closely with local community and business leaders, state and federal legislators, and volunteers to promote these is achievable and important goal. www.unitedwaysca.org

Children Now

Ted Lempert, President – Contact Ronald Pineda at 510-763-2444 x119 to speak to Ted, or contact Ted directly at 510-763-2444 x155 or 650-245-8166